Health Brief: Week in Review & What’s Ahead

Week in Review

August recess brings no health care certainty

Senate Republicans left Washington for the August recess without a clear path forward on health care. GOP leaders want to move on to other issues, while conservatives and the White House hope to revive the push to repeal the Affordable Care Act and centrists aim to bolster the law’s exchanges for next year.

Before adjourning, the Senate confirmed President Donald Trump’s pick for surgeon general, and several other Department of Health and Human Services officials.

Senate HELP Committee works on ACA stabilization bill

Senate Health, Education, Labor and Pensions Committee leaders have just a few weeks to bridge deep partisan divisions in their push to negotiate a bill by mid-September to bolster the ACA’s exchanges. It’s unclear what policies will take shape, but there is some bipartisan agreement that lawmakers should extend key cost-sharing reductions to insurers that Trump has threatened to cut off.

Insurers grapple with marketplace uncertainty

Major insurers in Idaho, West Virginia, South Carolina, Iowa and Wyoming are seeking to hike premiums by as much as 30 percent or more next year to account for uncertain conditions in the exchanges.

Premiums for Obamacare consumers in California are expected to increase by an average of 12.5 percent next year, but that number could almost double if cost-sharing reductions are scrapped. All 11 insurers that currently sell plans in California will apply for the exchange next year, though Anthem intends to withdraw from 16 of the state’s 19 regions.

Big insurers are reducing their participation in the ACA in areas where fighting over the future of the law is contributing to financial losses. Instead, they are looking for business opportunities through Medicare Advantage, a politically popular program that’s being embraced by a growing number of seniors.

Molina Healthcare Inc. plans to exit Obamacare exchanges in Wisconsin and Utah, and is also eliminating about 1,500 jobs in a restructuring plan it hopes will save $300 million to $400 million by late next year.

The Senate unanimously passed a “right to try” bill that would prohibit the federal government from denying terminally ill patients access to experimental drugs that have not been approved by the Food and Drug Administration. The chamber also sent legislation to President Donald Trump to reauthorize four user fee agreements that fund the FDA’s review of drugs and medical devices.

“Pharma bro” Martin Shkreli convicted of securities fraud

Martin Shkreli, a former pharmaceutical company executive who gained notoriety for hiking the price of a decades-old AIDS treatment by 5,000 percent, was convicted on three counts of securities fraud over unrelated allegations that he lied to investors. Shkreli faces up to 20 years in prison, though experts expect the final sentence to be much shorter in length.

What’s Ahead

The next few weeks will be pivotal for health insurers, who have to decide whether to participate in the ACA exchanges next year and set premium prices without assurance from the White House that they will continue to receive cost-sharing reduction payments for low-income enrollees.

When Congress returns in September, Republicans have a big to-do list that could make it difficult for them to move forward on any health care proposal, be it legislation to bolster the ACA’s exchanges or repeal the law.

One must-pass legislative item is passing a reauthorization of the Children’s Health Insurance Program before it expires at the end of September.